Options to Reduce Discomfort During Gynecological Exams

Gynecological exams — like Pap tests, pelvic exams, or fertility ultrasounds — are an important part of your reproductive health. For many patients, they can be uncomfortable, or anxiety-provoking. There are many ways to make the experience more comfortable.

Before Your Appointment

• Ask questions: It’s completely okay to ask what will happen during the exam and why it’s needed.

• Share your concerns: Let your provider know if you’ve ever had pain, trauma, or anxiety related to exams.

• Request adjustments: You can ask for a smaller speculum, extra time, or a specific provider if that helps you feel more at ease.

• Dr. Dason (or your physician) may be able to prescribe you specific medication that may make the exam more comfortable for you

  • One option may be sublingual lorazepam to be taking 5-10 minutes prior to the start of the procedure; after the use of lorazepam, patients cannot drive and usually require someone to take them home

  • Another option may be the use of external lidocaine gel to prevent the shock of insertion

  • Penthrox (methoxyflurane) is also an option at TRIO fertility under the guidance of an nurse practitioner - this is an inhaled anesthetic that must be prescribed and monitored; patients cannot drive and usually require someone to take them home after the use of this

    
    

During the Exam

• Relax your muscles: Try slow, deep breathing. Relaxing your core and thigh muscles helps reduce tension. Think of the muscle that you use to hold or release your bladder and focus on relaxing that muscle. Wiggling your toes can help as well.

• Use distraction: Listening to music, guided breathing or conversation can help shift focus away from discomfort. You can bring your own headphones and download a show, podcast, playlist or meditation to listen to. You can bring a comfort item (i.e. blanket) or a stressball to squeeze as well.**

• You’re in control: You can ask to pause or stop at any time. You can guide insertion yourself if that helps you feel in control.

• Position adjustments: Placing your fists under your hips, or slightly repositioning your legs, can sometimes help reduce pressure.

• Lubrication: there are some exams where lubrication can be used and ones where it cannot; ask your provider for more details.

**consider developing a 5 senses 'sensory safety kit' which involves creating a self-care package that stimulates all 5 senses in a pleasurable and calm way, which you can then bring to your clinical appointments to provide grounding and as a means to 'take-up space' in a clinical environment which can often feel dehumanizing - watch this helpful video

After the Exam

• Mild spotting or cramping: This can be normal after a Pap test or speculum exam. It should be light and settle within a day.

• Discomfort lasting more than 24 hours, fever, or heavy bleeding: Let your healthcare team know.

• Feedback matters: If something felt uncomfortable or triggering, please share it. It helps your provider tailor your care in the future.

  
  

More Tips that may be helpful :

If you have a history of pelvic pain, vaginismus, menopause-related dryness, or previous trauma:

• Ask if there is an alternative to the exam suggested (i.e. transabdominal imaging rather than transvaginal imaging)

• Ask if a longer appointment is possible and ask for breaks if needed

• Request a speculum to practice inserting at home to get used to the sensation and sounds associated with insertion

• Ask about topical numbing gel that can be picked up and applied before the exam

• Ask about the use of an anti-anxiety medication such as lorazepam prior to exams.

• Consider pelvic floor physiotherapy to reduce pain and muscle tension.

• Ask to insert the speculum yourself — many patients find this empowering and more comfortable.

• You can always bring a support person with you.

  
  

Remember

A gynecological exam should never feel like something happening to you — it should be something done with you, at your pace, with your comfort and dignity at the center.

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this does not represent medical advice and is for general education only

**resources adapted from Alexandra Blight - trauma-informed nurse practitioner at Trio Fertility